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June 24, 1992

Evolving Strategies for the Management of Atrial FibrillationThe Role of Amiodarone

Author Affiliations

From the Cardiac Arrhythmia Service, New England Medical Center Hospital, Tufts University School of Medicine, Boston, Mass.

JAMA. 1992;267(24):3332-3333. doi:10.1001/jama.1992.03480240094042

Management strategies for the most common sustained cardiac arrhythmia,1,2 atrial fibrillation, have undergone considerable evolution over the last several years. The objectives of therapy are to slow ventricular rate and restore and maintain sinus rhythm. Prevention of symptoms and reduction in the risk of complications such as stroke are therapeutic goals with agents that slow atrioventricular nodal conduction, antiarrhythmic agents, and anticoagulants.

The utility of digoxin for rate control has been questioned with recent studies suggesting that this former mainstay of therapy may now play a subsidiary role.3 β-Blockers and calcium channel blockers are now frequently used for slowing ventricular response. Concerns regarding the safety of quinidine have been raised by a recent meta-analysis showing an increased mortality in patients randomized to quinidine therapy or placebo for atrial fibrillation,4 although there are many limitations to this retrospective analysis. These safety concerns have been extended with recent observations